Medical and economic implications of prolonged mechanical ventilation and expedited post-acute care

Semin Respir Crit Care Med. 2012 Aug;33(4):357-61. doi: 10.1055/s-0032-1321985. Epub 2012 Aug 8.


This article describes the increasingly common phenomenon of prolonged mechanical ventilation in the context of the transition between the acute care hospital and post-acute care. Prolonged mechanical ventilation or chronic critical illness is associated with hospital mortality in the range of 20 to 40%, with median hospital length of stay ranging from 14 to 60 days. Fewer than 10% of patients are discharged home, and most hospital survivors require institutionalized post-acute care in the form of long-term acute care, skilled nursing facilities, or inpatient rehabilitation. Acute hospital readmission is common. Because of prolonged functional disabilities and multiple underlying comorbid conditions, overall 1 year mortality for prolonged mechanical ventilation patients ranges from 50 to 60%. Survivors experience significant functional limitations. The prolonged institutional care and poor long-term outcomes of these patients bring into question the cost-effectiveness of prolonged mechanical ventilation after acute illness, especially for patients with poor long-term prognoses. New measures to facilitate assessments of long-term prognosis and improve communication with surrogate decision makers may reduce the amount of ineffective care for some patients requiring prolonged mechanical ventilation.

Publication types

  • Review

MeSH terms

  • Aftercare / economics*
  • Aftercare / statistics & numerical data
  • Cost of Illness
  • Critical Care / economics*
  • Critical Care / statistics & numerical data
  • Critical Illness / economics*
  • Critical Illness / rehabilitation
  • Humans
  • Intensive Care Units / economics*
  • Intensive Care Units / statistics & numerical data
  • Length of Stay / statistics & numerical data
  • Long-Term Care / economics*
  • Long-Term Care / statistics & numerical data
  • Patient Readmission / statistics & numerical data
  • Prognosis
  • Respiration, Artificial / economics*
  • Respiration, Artificial / mortality
  • Respiration, Artificial / statistics & numerical data
  • Survivors / statistics & numerical data
  • Treatment Outcome